C/t 89 yo female c/o intermittent diarrhoea and significant | Figure 1

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C/t 89 yo female c/o intermittent diarrhoea and significant weakness for 2/52. Pt has been bed bound for 1/52 due to weakness. HR on arrival 30bpm and BP 80/40. All other obs wnl. Nil pain, GCS 15. PMH: AF, x2 CVA's 2016, x3 MI's over last 10 years, CABG 2014, hx of SVT and ablation therapy in 2015, HTN. Meds: Bisoprolol, Digoxin, Doxazosin, Atorvastatin and warfarin. 12-lead shows significant bradycardia with bigeminy at 34 bpm. IV access gained and x2 doses Atropine administered (total 1.2mg). 1st ECG (pre Atropine), 2nd ECG (post 1st dose Atropine), 3rd ECG (post 2nd dose Atropine). Atropine only increased HR to about 45-50bpm but BP improved to 160/80. Pt conveyed to nearest A&E. What is the rhythm? And what is causing it?

2nd shift as a full fledged medic and get called to local SNF for an unresponsive. Found an 82 yoF Alzheimer's pt awake but AMS (according to staff) saying "I'm going to do, I don't want to die". Initial pulse in high 40's-50 and initial BP of 72/44. 12-lead unremarkable. Trendelenburg raised BP a little but then I pushed 0.5mg of atropine which raised BP to 105/66 with the HR as seen (which is her normal HR). Gave her a 200 cc bolus also. HR maintained for the 12-minute transport. She just finished a course of Bactrim for a UTI but afebrile. Any thoughts? I see sinus with PACs after atropine

Elderly patient presented with weakness. 1st image: 12lead ECG. 2nd: Intracardiac tracing from a pacing catheter located at the inferior portion of the interatrial septum. Where's the level of block?

81 male c/o 1 day generalized weakness, fatigue. - c/p, SOB, nausea or vomiting, - light-headedness or dizziness. Hx HTN, high triglycerides. Rx Lisinopril, Tricor and Plavix. BP 180/80, RR 16, SpO2 98% on 4 lpm. Skins WNL. Pacer pads placed as precaution. HR remained between 35 and 40. Thoughts on rhythm?... I think it's a 2nd degree type 2.

52 year old male presented with atypical chest pain and dyspnea ECG normal twice one hour apart Cardiac enzymes -ve Dyspnea is more prominent when the pt is sitting or leaning foreword The pt is comfortable at lying down on his back Bp was 130/80 HR 80 So2 at room air 99% After one hour Bp was 80/60 So2 97 % room air Heart sounds are difficult to hear What do think of the Chest xray ?